Alcoholic Liver Disease or ALD

Alcoholic Liver Disease

Alcohol is a toxic substance to the liver and remains one of the most common causes of chronic liver disease.

The spectrum of ALD is broad and a single patient may be affected by more than one of the following conditions;fatty liver, alcoholic hepatitis or alcoholic cirrhosis.

EPIDEMIOLOGY

ALD does not occur below a threshold of 21 units/week in women and 28 units/week in men. One unit is equal to 8g of alcohol , one glass of wine (125ml) or one 240ml can of 3.5-4% of beer. The average alcohol consumption of an individual with cirrhosis is 160g/day for an average of 8 years. Approx. 30-40 units of alcohol per week can induce cirrhosis in 3%-8% of individuals over 12 years.Fatty liver is the most commonly observed abnormality and occurs in upto 90% of alcoholics.

Alcoholic cirrhosis is a common cause of ESLD , cirrhosis and hepatocellular carcinoma.

AETIOLOGY

Acetaldehyde: 80% of alcohol is metabolised to acetaldehyde by enzyme alcohol dehydrogenase. Acetaldehyde forms adducts with cellular proteins in hepatocytes which activate the immune system leading to cell injury.

20% of alcohol is metabolised by the mixed function oxidase enzymes of the smooth endoplasmic reticulum. Cytochrome CYP2E1 is induced by alcohol, which increases oxygen consumption and lipid peroxidation. Microsomal peroxidation leads to oxygen free radicals which can induce mitochondrial damage.

Cytokines: increased endotoxin is released into blood in alcoholic hepatitis via increased gut permeability. TNF-? production is increased from monocytes . release of IL-1,2 and 8 also occurs. These cytokines are also involved in fibrogenesis.

PATHOGENESIS

Cirrhosis develops when there is chronic and severe inflammation of the liver for an extended period of time. The regenerative capacity of the liver is enormous however over a long time fibrosis develops.

And when at least 70-80% of liver function has been lost the synthetic capacity of the liver is diminished.

PATHOLOGICAL FEATURES OF ALCOHOLIC LIVER DISEASE

Alcoholic hepatitis: lipogranuloma

Neutrophil infiltration

Mallory’s hyaline

Pericellular fibrosis

Macrovesicular steatosis

Fibrosis and cirrhosis

Central hyaline sclerosis

CLINICAL FEATURES

Alcohol is a toxic substance to the liver and remains one of the most common causes of chronic liver disease.

The spectrum of ALD is broad and a single patient may be affected by more than one of the following conditions;

Dr Mahesh Shrestha

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